System Guide
Back to Search Results

Search Results

Display Options
Display Options
Select Fields
Export Results to CSV Create Report 0
+ Add all results to report

Report Produced: 02/27/2026 11:12 AM

Report Question ID Question Discussion Answer Year
20110070 MP/H Rules/Histology--Endometrium: How is histology coded when clear cell adenocarcinoma [8310/3] is stated to involve a "1.5 cm endometrial polyp"? See Discussion.

The CAP formatted pathology report histology field states, "Clear cell adenocarcinoma, NOS 98310/3)" and the tumor size comment field states, "Carcinoma involves a 1.5 cm endometrial polyp." Does rule H11 apply? Is the histology coded to clear cell adenocarcinoma [8310/3] because this is one histologic type identified in the CAP formatted histology field? Or should rule H12 apply and the histology coded as clear cell adenocarcinoma arising in a polyp [8210/3]? Or should we code the higher histology per rule H17 apply because clear cell adenocarcinoma and adenocarcinoma in a polyp are two specific histologies?

For colon primaries, whether or not the tumor arose in a polyp is quite important. Is this also the case for primaries listed in the Other Sites category?

Code histology to 8310/3 [clear cell adenocarcinoma]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later.

The following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For an endometrial primary, use the Other Sites Histo rules to determine the histology code because endometrium does not have site specific rules.

Go to the SINGLE TUMOR: INVASIVE ONLY module, which starts at Rule H8.

. Code clear cell adenocarcinoma [8310/3] because only one histologic type is identified.

2011
20110008 MP/H Rules/Histology--Vulva: How is histology coded for VIN III with focal invasion? See Discussion. Per SINQ 20000442, the histology for CIN III with microinvasion is coded to 8077 [squamous intraepithelial neoplasia, grade III] per the matrix system rules, with a behavior code of /3 [malignant]. Coding the histology to 8077/3 per the matrix principle causes IF25_3 and MorphICDO3_P1 edits to fail. Flagging the first error resolves any reporting issue. How is the MorphICDO3_P1 edit resolved? Assign 8076/3 [squamous cell carcinoma, microinvasive] for VIN III with focal invasion. This applies to all terminologies listed under 8077/2. The SINQ question from 2000 will be retired. 2011
20110102

Reportability--Heme & Lymphoid Neoplasms: For cases diagnosed 2010 and later, are idiopathic thrombocytopenia and autoimmune thrombocytopenia reportable?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Idiopathic and autoimmune types of thrombocytopenia are not reportable. Thrombocytopenia and thrombocythemia are not synonyms. Cytopenia and cythemia have different definitions. See Appendix F: Non-Reportable List for Hematopoietic Diseases.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

 2011
20110010

Multiple primaries--Heme & Lymphoid Neoplasms: Is a recently diagnosed granulocytic sarcoma followed by a diagnosis of AML two primaries? See Discussion.

6/10/10 Axillary lymph node biopsy was compatible with AML. The physician noted that the patient was diagnosed with granulocytic sarcoma [9930/3] in the axillary node.

6/15/10 Bone marrow biopsy compatible with AML FAB M1 [9873/3].

After induction, a second bone marrow biopsy on 6/30/10 shows persistent/refractory AML. The physician noted that the second biopsy is compatible with AML FAB M7 [9910/3].

Is the granulocytic sarcoma a chronic form of the disease? If so, do we have one primary diagnosed 6/10/10 with primary site coded to C42.1 and histology coded to 9873/3? Does the second biopsy on 6/30/10 represent the same primary even though the persistent disease is now FAB M7?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Granulocytic sarcoma does not transform into AML. Per the Abstractor Notes section in the Heme DB under the term "granulocytic sarcoma," it indicates that "Myeloid sarcoma (also known as granulocytic sarcoma) may occur de novo; it may precede or coincide with AML, or represent an acute blastic transformation of myelodysplastic syndromes." This means that when granulocytic/myeloid sarcoma is seen with AML, it represents a solid manifestation of the systemically involved AML. In other words, it is all the same disease process (coded to AML) if it occurs simultaneously (i.e., at the same time or within 21 days of on another).

Apply Rule M3 to this case which states to abstract a single primary when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Code the primary site to C421 [bone marrow] with histology coded to 9873/3 [acute myeloid leukemia, M1]. The FAB category is an older classification that is seldom used. Changes from FAB 1 to FAB 7 do not constitute a new primary.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

 2011
20110005 Histology--Heme & Lymphoid Neoplasms: How is the pre-2010 histology coded for a "follicular grade 2, non-Hodgkin lymphoma with marginal zone B-cell differentiation"? See Discussion. This patient was seen in 2010 for the same primary as diagnosed in 2006. The histology was coded to marginal zone lymphoma [9699/3] in 2006. Is this correct? Or should this have been coded as a follicular lymphoma, ignoring the modifying expression "marginal zone B-cell differentiation"?

This is a 2006 diagnosis. The histology code is 9691/3 [follicular lymphoma, grade 2]. Do not code differentiation for hematopoietic cases.

For diagnoses 2010 and forward, a small number of cases of follicular lymphoma do have marginal zone differentiation. However, there is no code for this variant of follicular lymphoma. It would simply be coded as a follicular lymphoma because that is the most accurate histology code available. The marginal zone differentiation is not to be coded as a second primary (marginal zone lymphoma).

2011
20110140 MP/H Rules/Behavior--Breast: How are behavior and histology coded when the pathology report final diagnosis is "ductal carcinoma in situ and lobular carcinoma in situ" if the microscopic examination section of the same pathology report states there are "foci suspicious for microinvasive carcinoma"? See Discussion. The pathology report microscopic examination states, "focally, between ducts involved by DCIS, there are minute tubular structures associated with stromal fibrosis and chronic inflammation. These foci are suspicious for microinvasive carcinoma."

For cases diagnosed 2007 or later, code one primary with histology and behavior coded to 8522/2 [intraductal carcinoma and lobular carcinoma in situ].

The steps used to arrive at this decision are as follows

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histology rules. The module you use depends on the behavior and number of tumors identified in the primary site. The information provided does not specify whether this was a single tumor with DCIS and LCIS or multiple tumors with DCIS and LCIS. In this case, the number of tumors does not change the histology code for this patient. For this example, assume this disease process was a single tumor.

Start at the SINGLE TUMOR: In Situ Carcinoma Only module. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H8. Stop at the first rule that applies to the case you are processing. Code the histology as 8522/2 (intraductal carcinoma and lobular carcinoma in situ) when there is a combination of in situ lobular (LCIS) [8520] and intraductal carcinoma (DCIS).

Do not code the behavior as invasive in this case. The pathologist indicated that these findings were "suspicious" but not definite in the microscopic examination. If the pathologist decided that this was truly an invasive tubular element, it would have been included in the final diagnosis.

2011
20110068 MP/H Rules/Multiple primaries--Bladder: Which multiple primary rule is used to determine the number of primaries to accession when a patient has a papillary transitional cell carcinoma of the bladder diagnosed in 2009 followed by a high grade invasive urothelial carcinoma with neuroendocrine features per immunohistochemistry diagnosed in 2010? See Discussion.

A patient has papillary transitional cell carcinoma of the bladder in March of 2009. In June of 2010 the patient has another TURBT that demonstrates a flat in situ and invasive high grade urothelial carcinoma. The path addendum indicates, "Genzyme IHC show results consistent with high grade invasive urothelial carcinoma with neuroendocrine features." Two months later a liver biopsy shows poorly differentiated malignant tumor. The path addendum indicates, "Genzyme IHC results show metastatic poorly differentiated carcinoma with neuroendocrine features, favor bladder primary."

Is the latter a second bladder primary with histology code 8246/3 [neuroendocrine carcinoma]?

NOTE: Neuroendocrine is not listed as an urothelial tumor in Table 1 of MP/H Rules.

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary. The 2010 diagnosis is urothelial carcinoma. The presence of "neuroendocrine features" does not change the histologic category.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Urinary MP rules under one of the three formats (i.e., flowchart, matrix or text). The rules are intended to be reviewed in consecutive order within the module. You stop at the first rule that applies to the case you are processing.

Start at the MULTIPLE TUMORS module start at rule M3.

. Bladder tumors with any combination of transitional cell carcinoma and papillary transitional carcinoma are a single primary.

2011
20110016 Behavior--Brain and CNS: Can hemangioblastomas occurring in the CNS be coded as /3 (malignant) based on a radiologic or clinical diagnosis by the physician? See Discussion. Hemangioblastomas are borderline (/1) according to ICD-O. The standard matrix rule in ICD-O directs registrars to change the behavior code to malignant when a malignant (/3) behavior is stated by a physician for a morphology code that appears in ICD-O with a non-malignant behavior code. The "malignant" hemangioblastomas we see are not pathologically confirmed; they are radiological or clinical diagnoses confirmed when renal cell carcinoma is a disease process listed in the malignant differential diagnoses.

The behavior code for hemangioblastoma can be coded to /3 when a pathologist indicates that the behavior is malignant. The behavior code should be based on a pathologist's opinion. It is usually not possible for a radiologist or patient care physician to make this determination clinically.

The histologic appearance of hemangioblastoma may resemble metastatic renal cell carcinoma; therefore, one will often see renal cell carcinoma listed as a possible diagnosis. This does not indicate that the hemangioblastoma is malignant. Do not code the behavior as /3 based on a differential diagnosis of renal cell carcinoma.

2011
20110074 First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer. 2011
20110057

MP/H Rules/Behavior--Appendix: How do you code mucinous cancers of the appendix? Is a "low grade mucinous appendix tumor/neoplasm" with peritoneal spread reportable? See Discussion.

Low grade mucinous neoplasms can spread to the peritoneal cavity and in that sense are metastatic but histologically have bland/benign features (may be a benign cystadenoma that ruptured and spread by rupturing) are not a carcinoma. Thus, some have termed this group as DPAM (diseminated peritoneal adenomucinous) and not a true carcinoma. Others indicate that if you have metastasis the tumor is a carcinoma.

For cases diagnosed 2007 or later, low-grade mucinous tumors of the appendix are a /1, borderline/uncertain behavior, and not reportable. These tumors do spread to the peritoneal cavity (pseudomyxoma peritonei). This spread, or deposits, or implants are also borderline/uncertain behavior and do not make the appendiceal tumor reportable. By contrast, a high-grade mucinous tumor of the appendix may produce malignant/invasive pseudomyxoma peritonei. When the pseudomyxoma peritonei are diagnosed as invasive or malignant, the mucinous tumor in the appendix is reportable as a /3.

 2011